Fla. Admin. Code R. 59B-14.002
Current through Reg. 50, No. 235-239, December 10, 2024
Section 59B-14.002 - Definitions(1) "Health plan" means a health benefit plan as defined in Section 627.6699(3)(k), F.S., that is, any hospital or medical policy or certificate, hospital or medical service plan contract, or health maintenance organization subscriber contract. The term does not include accident-only, specified disease, individual hospital indemnity, credit, dental-only, vision-only, Medicare supplement, long-term care, or disability income insurance; similar supplemental plans provided under a separate policy, certificate, or contract of insurance, which cannot duplicate coverage under an underlying health plan and are specifically designed to fill gaps in the underlying health plan, coinsurance, or deductibles; coverage issued as a supplement to liability insurance; workers' compensation or similar insurance; or automobile medical-payment insurance. The term does not include Medicare health plans, Medicaid health plans, or Florida Healthy Kids health plans described in Section 624.91, F.S. The term does not include limited or short term hospital, medical or surgical benefit policies.(2) "Measurement year" means the year prior to the year in which the report is due to be submitted to the Agency for Health Care Administration (agency).(3) "Insured" means a person who has health care coverage under a health plan of the health insurer.(4) "Covered lives" means the sum of primary insureds (the total number of resident individual policyholders or resident group employee or member certificateholders) and covered dependents (the total number of individuals who are covered by the primary insured's plan and who receive coverage due to his or her dependent relationship to the primary insured).(5) "Cost sharing" means any co-insurance, co-payment, deductible or similar arrangement the member agrees to pay upon receipt of covered health care services.Fla. Admin. Code Ann. R. 59B-14.002
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061(1)(c), (e) FS.